Philip M Jones1,2,3, Britney N Allen4, Richard A Cherry5, Luc Dubois6, Kelly N Vogt7,6, Salimah Z Shariff4,8, Krista M Bray Jenkyn4, Sheila Riazi9,10, Duminda N Wijeysundera9,10,11,12,13. 1. Department of Anesthesia & Perioperative Medicine, University of Western Ontario, London, ON, Canada. philip.jones@lhsc.on.ca. 2. Department of Epidemiology & Biostatistics, University of Western Ontario, London, ON, Canada. philip.jones@lhsc.on.ca. 3. London Health Sciences Centre, University Hospital, Room C3-110, 339 Windermere Rd, London, ON, N6A 5A5, Canada. philip.jones@lhsc.on.ca. 4. Institute for Clinical Evaluative Sciences, Western Site (ICES Western), London, ON, Canada. 5. Department of Anesthesia & Perioperative Medicine, University of Western Ontario, London, ON, Canada. 6. Department of Surgery, University of Western Ontario, London, ON, Canada. 7. Department of Epidemiology & Biostatistics, University of Western Ontario, London, ON, Canada. 8. Arthur Labatt School of Nursing, University of Western Ontario, London, ON, Canada. 9. Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada. 10. Department of Anesthesia, University of Toronto, Toronto, ON, Canada. 11. Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. 12. Institute of Clinical Evaluative Sciences, Central Site (ICES Central), Toronto, ON, Canada. 13. Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Abstract
PURPOSE: Whether current standards of care management for malignant hyperthermia (MH)-susceptible patients result in acceptable postoperative clinical outcomes at a population level is not known. Our objective was to determine if patients with susceptibility to MH experienced similar outcomes as patients without MH susceptibility after surgery under general anesthesia. METHODS: This was a retrospective, population-based cohort study from 1 April 2009 until 31 March 2016 in the Canadian province of Ontario. Participants were adults who underwent common in- or outpatient surgeries under general anesthesia. The exposure studied was either known or strongly suspected MH susceptibility as determined by usage of a specific physician billing code. The primary outcome was a composite of all-cause death, hospital readmission, or major postoperative complications, all within 30 postoperative days. Separate analyses were employed, based on whether a patient had in- or outpatient surgery. Inverse probability of exposure weighting based on the propensity score was used to estimate adjusted exposure effects. RESULTS: The cohort included 957,876 patients (583,254 in- and 374,622 outpatients). There were 2,900 (0.3%) patients with a known or strong suspicion of MH susceptibility. For inpatients, the primary outcome occurred in 146,192 (25.1%) of the non-MH-susceptible group and in 337 (20.1%) of the MH-susceptible group (unadjusted risk difference [RD], -5.0%; 95% confidence interval [CI], -6.9 to -3.1%; P < 0.001). In outpatients, the primary outcome occurred in 9,146 (2.4%) of the non-MH-susceptible group and in 32 (2.6%) of the MH-susceptible group (RD, 0.2%; 95% CI, -0.7 to 1.1%; P = 0.72). After adjustment, MH susceptibility was not associated with the primary outcome in either the inpatients (adjusted risk difference [aRD], 1.2%; 95% CI, -1.3 to 3.6%; P = 0.35) or outpatients (aRD, -0.1%; 95% CI -1.0 to 0.9%; P = 0.90). CONCLUSIONS: Among adults in Ontario who underwent common surgeries under general anesthesia from 2009 to 2016, known or strongly suspected MH was not associated with a higher risk of adverse postoperative outcomes. These findings support the current standard of care management for MH-susceptible patients.
PURPOSE: Whether current standards of care management for malignant hyperthermia (MH)-susceptible patients result in acceptable postoperative clinical outcomes at a population level is not known. Our objective was to determine if patients with susceptibility to MH experienced similar outcomes as patients without MH susceptibility after surgery under general anesthesia. METHODS: This was a retrospective, population-based cohort study from 1 April 2009 until 31 March 2016 in the Canadian province of Ontario. Participants were adults who underwent common in- or outpatient surgeries under general anesthesia. The exposure studied was either known or strongly suspected MH susceptibility as determined by usage of a specific physician billing code. The primary outcome was a composite of all-cause death, hospital readmission, or major postoperative complications, all within 30 postoperative days. Separate analyses were employed, based on whether a patient had in- or outpatient surgery. Inverse probability of exposure weighting based on the propensity score was used to estimate adjusted exposure effects. RESULTS: The cohort included 957,876 patients (583,254 in- and 374,622 outpatients). There were 2,900 (0.3%) patients with a known or strong suspicion of MH susceptibility. For inpatients, the primary outcome occurred in 146,192 (25.1%) of the non-MH-susceptible group and in 337 (20.1%) of the MH-susceptible group (unadjusted risk difference [RD], -5.0%; 95% confidence interval [CI], -6.9 to -3.1%; P < 0.001). In outpatients, the primary outcome occurred in 9,146 (2.4%) of the non-MH-susceptible group and in 32 (2.6%) of the MH-susceptible group (RD, 0.2%; 95% CI, -0.7 to 1.1%; P = 0.72). After adjustment, MH susceptibility was not associated with the primary outcome in either the inpatients (adjusted risk difference [aRD], 1.2%; 95% CI, -1.3 to 3.6%; P = 0.35) or outpatients (aRD, -0.1%; 95% CI -1.0 to 0.9%; P = 0.90). CONCLUSIONS: Among adults in Ontario who underwent common surgeries under general anesthesia from 2009 to 2016, known or strongly suspected MH was not associated with a higher risk of adverse postoperative outcomes. These findings support the current standard of care management for MH-susceptible patients.
Authors: Joilson M Santos; Pamela V Andrade; Leonardo Galleni; Mariz Vainzof; Claudia F R Sobreira; Beny Schmidt; Acary S B Oliveira; José L G Amaral; Helga C A Silva Journal: Can J Anaesth Date: 2017-09-26 Impact factor: 5.063
Authors: Marilyn Green Larach; Gerald A Gronert; Gregory C Allen; Barbara W Brandom; Erik B Lehman Journal: Anesth Analg Date: 2010-02-01 Impact factor: 5.108
Authors: Danielle A Southern; Bernard Burnand; Saskia E Droesler; Ward Flemons; Alan J Forster; Yana Gurevich; James Harrison; Hude Quan; Harold A Pincus; Patrick S Romano; Vijaya Sundararajan; Nenad Kostanjsek; William A Ghali Journal: Med Care Date: 2017-03 Impact factor: 2.983
Authors: Jan P Vandenbroucke; Erik von Elm; Douglas G Altman; Peter C Gøtzsche; Cynthia D Mulrow; Stuart J Pocock; Charles Poole; James J Schlesselman; Matthias Egger Journal: PLoS Med Date: 2007-10-16 Impact factor: 11.069
Authors: Eric I Benchimol; Liam Smeeth; Astrid Guttmann; Katie Harron; David Moher; Irene Petersen; Henrik T Sørensen; Erik von Elm; Sinéad M Langan Journal: PLoS Med Date: 2015-10-06 Impact factor: 11.069